Save Time at Your Visit
New Patients Form
Complete your medical history and dental goals online before your appointment. It takes about 10 minutes.
Online Intake Form
What You'll Be Asked
Filling out the form takes about 10 minutes. It's split into two short steps covering your personal details, medical history, and dental history. All information is confidential and reviewed only by your dental team.
Personal Details
- First & last name
- Sex
- Birth date
- Marital status
- How you heard about us
Medical History
- Care under a medical doctor in the past two years
- Allergies and adverse reactions to medications
- Existing conditions (heart, diabetes, asthma, thyroid, etc.)
- Pregnancy / nursing / birth control (women — optional)
Your Smile Goals
- Veneers / crowns
- Sedation dentistry
- Replace metal fillings
- Replace missing teeth
- Correct misaligned teeth
- Broken or cracked teeth
- Dental implants
- TMJ / night guards · Sports guards · Whitening
Dental Concerns
- Dental anxiety / apprehension
- Previous dental crowns or implants
- Sensitivity to hot, cold, sweets, or sours
- Bleeding gums / slow-healing sores
- Difficulty chewing / TMD / headaches
- Sleep problems / clenching or grinding
Treatment Consent
Transparent. Informed. Always Your Choice.
At the end of the form you'll be asked to confirm the information is accurate and acknowledge that all dental services are your responsibility. We always discuss fees and treatment options before any work is done — no surprises, ever.
Ready to Start?
Got Your Appointment Booked?
Call us at 403-984-1616 if you have any questions about completing the form, or stop by during office hours and our team will help you finish it in person.